Our weekly wrap-up of antimicrobial stewardship & antimicrobial resistance scans
OIE report shows countries using fewer antimicrobials in animals
Originally published by CIDRAP News Jul 29
A new report from the World Organisation for Animal Health (OIE) shows a global decline in the use of antimicrobials in animals.
Of the 69 countries that provided data for 2015 through 2017, an overall decrease of 34% was observed, with antimicrobial quantities dropping from 174.01 milligrams per kilogram (mg/kg) to 114.84 mg/kg. Among the 102 countries reporting data for 2017, the estimated amount of antimicrobials used in animals was 107.68 mg/kg.
“The decrease in antimicrobial quantities adjusted by animal biomass in all OIE Regions represents countries’ commitment to the responsible use of antimicrobials in animals at the country level,” the reported stated.
While the report is the fifth published by the OIE on antimicrobials intended for use in animals, it’s the first to analyze trends among countries.
In addition, a record high 160 countries provided data for the report (a 23% increase in participation), and 133 countries reported more detailed quantitative data than in previous reports (a 16% increase). The report attributed that finding to countries continuing to develop their antimicrobial use monitoring systems.
Among other findings, 112 countries (70%) reported that they did not use any antimicrobial agents for growth promotion in animals, regardless of the presence or absence of national legislation. Twenty-three countries reported that a lack of regulatory framework, human resource constraints, and lack of information technology tools were barriers faced in reporting quantities of antimicrobials for use in animals.
Given these challenges, the OIE advises caution in interpreting the data.
“The OIE remains strongly committed to supporting its Members in developing robust and transparent measurement reporting mechanisms for antimicrobial use, but the challenges faced by many of our Members must not be under-estimated,” the report said. “While data collection systems further develop, this annual report will provide an essential global and regional analysis of antibiotic use in animals, and changes over time.”
Jul 27 OIE report
UK funds project to track resistant pathogens in food, agriculture
Originally published by CIDRAP News Jul 29
The UK government this week announced £19.2 million (US $26.8 million) in funding for a project that will use genomic technology to track foodborne and antibiotic-resistant pathogens through the food-production system.
The funding will help the Pathogen Surveillance in Agriculture, Food and the Environment (PATH-SAFE) program develop a pilot national surveillance network, using the latest DNA sequencing technology and environmental sampling, to improve detection and tracking of pathogens from farm to fork in all four nations of the United Kingdom, according to a press release from the UK’s Food Standards Agency.
The focus of the project will be the creation of a database for storing, analyzing, and sharing sequence and source data collected from multiple locations.
“This project is designed to help safeguard UK food, agriculture and consumers by using cutting edge technology to understand how pathogens and AMR [antimicrobial resistance] spread,” FSA Chief Scientific Officer Robin May, PhD, said. “Tracking the source of these issues will ultimately help us to develop better control strategies to reduce illness and deaths.”
Jul 27 FSA press release
Study: Nursing home intervention led to fewer antibiotics for UTIs
Originally published by CIDRAP News Jul 28
A tailored intervention implemented at nursing homes in Denmark reduced antibiotic prescriptions and unnecessary interventions for urinary tract infections (UTIs) without substantially increasing hospitalizations and mortality, Danish researchers reported last week in The Lancet Infectious Diseases.
In a cluster-randomized trial involving 22 nursing homes, 11 were randomized from June 1, 2017, to June 1, 2018, to receive interactive educational sessions on how to distinguish between a UTI and asymptomatic bacteriuria and evaluate non-specific symptoms, along with an algorithm to determine whether a UTI is likely. The remaining nursing homes continued standard UTI management.
While nursing home staff in Denmark (unskilled workers, nurses, healthcare assistants, and healthcare helpers) don’t prescribe antibiotics, the theory behind the intervention was that diagnosis and treatment of UTIs are directly influenced by the staff’s knowledge and communication skills.
The primary outcome of the trial was the number of antibiotic prescriptions for acute UTI per residents per days at risk in the intervention and control groups. Secondary outcomes included the appropriateness of antibiotic treatment for UTIs, all-cause hospitalizations, and all-cause mortality.
A total of 1,470 nursing home residents (765 in the intervention group and 705 in the control group) were analyzed for the primary endpoint. The number of prescriptions for UTI per resident was 134 per 84,035 days at risk in the intervention group, compared with 228 per 77,817 days at risk in the control group, for an unadjusted rate ratio (RR) of 0.51 (95% confidence interval [CI], 0.37 to 0.71) and an adjusted RR of 0.42 (95% CI, 0.31 to 0.57).
In terms of secondary outcomes, the risk of receiving appropriate antibiotic treatment (RR, 0.65; 95% CI, 0.41 to 1.06) and inappropriate (RR, 0.33; 95% CI, 0.23 to 0.49) treatment was lower in the intervention group. All-cause hospitalization increased in the intervention group (adjusted RR, 1.28; 95% CI, 0.95 to 1.74), but all-cause mortality was lower (adjusted RR, 0.91: 95% CI, 0.62 to 1.33).
“Our results imply that a broader range of health professionals should be engaged in antibiotic stewardship and that programmes should be tailored to address potential barriers to implementation and should focus on education, reflection, and a structured professional dialogue,” the study authors wrote.
Jul 22 Lancet Infect Dis abstract
Study: Use of restricted antibiotics rose after hospital ASP discontinued
Originally published by CIDRAP News Jul 27
The discontinuation of an antimicrobial stewardship program (ASP) at a South Korean hospital led to a rapid return of antibiotic use patterns observed before the ASP was implemented, researchers reported yesterday in Clinical Microbiology and Infection.
The interrupted time-series analysis looked at antibiotic use at the 859-bed hospital from September 2015 through August 2019. The hospital ASP, which focused on restricting the use of certain antibiotics, was implemented in September 2016 and discontinued in March 2018 after an infectious disease (ID) specialist resigned. Infection control measures at the hospital remained largely the same throughout the study period.
Immediately after discontinuation, the use of restrictive antibiotics increased by 41.06 days of therapy (DOT) per 1,000 patient-days in the hospital’s general ward and by 391.04 DOT/1,000 patient-days in the intensive care unit (ICU). Increases were driven by the use of carbapenems in the general ward and ICU and glycopeptides in the ICU. In addition, there were positive changes in the slope for the use of restrictive antibiotics in the general ward and the ICU.
While the use of broad-spectrum antibiotics declined after discontinuation of the ASP, the study authors suggest a large proportion of broad-spectrum antibiotic prescribing may have been shifted to restrictive antibiotics.
“Therefore, instead of a reduction in the use of broad-spectrum antibiotics, the use of restrictive antibiotics increased,” the authors wrote. “We suggest that the restrictive intervention for antibiotics is probably not educative and is not sustained.”
The study notes that the number of active ID specialists in South Korea is limited, and that despite an emphasis on the importance of antimicrobial stewardship, many ASPs have been discontinued because of a shortage of workers.
Jul 26 Clin Microbiol Infect study
FDA rejects new drug application for sulopenem
Originally published by CIDRAP News Jul 27
Pharmaceutical company Iterum Therapeutics said yesterday that the US Food and Drug Administration (FDA) has rejected the company’s new drug application (NDA) for approval of its oral antibiotic sulopenem etzadroxil/probenecid.
Iterum is seeking approval of the antibiotic for treatment of UTIs in patients who do not do not respond to treatment with fluoroquinolones. But in a Jul 23 Complete Response Letter (CRL) to the company, the FDA said it could not approve the NDA in its current form.
While the FDA acknowledged the results of a phase 3 clinical trial indicated that patients with ciprofloxacin-resistant UTIs had a better response to oral sulopenem compared with ciprofloxacin, the agency said additional data from another clinical trial are needed to support approval for treatment of women with uncomplicated UTIs caused by fluoroquinolone-resistant pathogens.
The FDA also recommended that Iterum conduct further nonclinical research to determine the optimal dosing regimen.
“We are disappointed in this outcome and believe that the data package submitted was adequate for the approval of oral sulopenem,” Iterum Therapeutics Chief Executive Officer Corey Fishman said in a company press release. “Regardless, we will evaluate the points raised in the CRL for discussion with the FDA to determine an expeditious path forward. We remain confident in the value of, and unmet medical need for, oral sulopenem to treat multi-drug resistant infections, including fast-growing quinolone non-susceptible pathogens.”
The company says sulopenem has received Qualified Infectious Disease Product and Fast-Track designations from the FDA for seven indications.
Jul 26 Iterum Therapeutics press release
Study: High antibiotic use in COVID patients with no co-infections
Originally published by CIDRAP News Jul 26
Nearly two thirds of COVID-19 patients without bacterial or fungal co-infections in Michigan hospitals received antibiotics during the first wave of the pandemic, University of Michigan researchers reported today in Infection Control & Hospital Epidemiology.
Of the 2,205 patients hospitalized for COVID-19 at 38 Michigan hospitals from Mar 16 through Aug 14, 2020, 141 (6.4%) had a co-infection; 3.0% were community-onset infections, and 3.4% were hospital-acquired. Among those with community-onset co-infection, 49.3% had respiratory infections, and 50.7% had bloodstream infections, while 77.2% of hospital-acquired infections were respiratory, and 22.8% were bloodstream infections. Among the patients with no co-infection, 64.9% received an antibiotic during hospitalization or at discharge.
Assessment of predictors for co-infection found that admission from a long-term care facility (odds ratio [OR], 3.98; 95% CI, 2.34 to 6.76) and admission to intensive care (OR, 4.34; 95% CI, 2.87 to 6.65) were associated with increased risk of community-onset infection. Hospital-acquired co-infection predictors included fever (OR, 2.46; 95% CI, 1.15 to 5.27) and advanced respiratory support (OR, 40.72; 95% CI, 13.49 to 122.93). Both community-onset and hospital-acquired co-infection were associated with higher in-hospital and 60-day mortality.
The findings are in line with previous studies from several countries that have found high rates of antibiotic use in COVID-19 patients, despite low prevalence of co-infection.
The study authors say knowing the incidence and predictors of community-acquired and hospital-onset infections could help efforts to reduce unnecessary antibiotic use in COVID-19 patients.
“Interventions reducing unnecessary antibiotics in COVID-19 patients could potentially reduce the global emergence of multidrug resistant organisms, adverse events such as renal injury, and even mortality,” they wrote.
Jul 26 Infect Control Hosp Epidemiol abstract
Study highlights need for better antibiotic stewardship at discharge
Originally published by CIDRAP News Jul 26
A review of electronic health records at three Indiana hospitals found patients receiving prolonged courses of antibiotic therapy for common types of infections, researchers reported last week in Open Forum Infectious Diseases.
The review, conducted from January through June 2019, looked at all adult patients who began antibiotic therapy at the hospitals and continued antibiotic therapy after discharge, focusing on patients with skin/soft tissue infection (SSTI), UTI, community-acquired pneumonia (CAP), or acute exacerbation of chronic obstructive pulmonary disease (AECOPD). The days of therapy (DOT) for each inpatient and outpatient antibiotic prescribed were collected to calculate the total DOT for each patient.
Of the 547 patients included in the review, 233 (42.6%) had CAP, 120 (21.9%) had uncomplicated UTI, 101 (18.5%) had SSTI, and 93 (17%) had AECOPD. The median duration of antibiotic therapy across all indications was 9 days, with a median duration of 9 days for CAP (4 days longer than recommended minimum treatment), 8 days for UTI (3 to 5 days longer), 12 days for SSTI (5 to 7 days longer), and 7 days for AECOPD (2 to 4 days longer). The most common antibiotics prescribed at discharge were cephalosporins, amoxicillin/clavulanate, and fluoroquinolones.
The authors say it is essential that clinicians account for DOT completed during hospital admission to determine the remaining DOT necessary following discharge and prevent excessive antibiotic durations. “Transitions of care remain an area for improvement for hospital antibiotic stewardship programs,” they wrote.
Jul 24 Open Forum Infect Dis abstract